Dental Problems and Care Of The Elderly

Oral health is an important indicator of our overall health. Untreated dental problems can become cause of other diseases in the elderly. The reverse is also true as the immune system of the elderly is not very strong. Systemic diseases like diabetes, leukemia, cancer, heart and kidney diseases are all interlinked with dental problems. Weak or loss of teeth also means difficulty in eating leading to lack of nutrition. Therefore it is of utmost importance to take care of the dental hygiene of the elderly.

After years of eating, drinking, chewing and brushing, some depreciation of the teeth with age is natural. The facialmuscles become soft and fragile and the stretching capacity of the gums is lost. The teeth become weak and fragile and the receding gums make the teeth susceptible to gum diseases. The elderly are often unable to take proper care of their teeth due to overall weakness or problems like arthritis, making it difficult to stand for long in front of the sink and brush/floss thoroughly.

The common dental problems of the elderly are-
1. Receding gums- Gums are like protective blankets for the tooth roots. Significant gum tissue is lost leading to receding gums, with years of harsh brushing. Receding gums are a cause of concern because it exposes the teeth to infections, and hence better regular cleaning of teeth is required.

2. Sensitive teeth- The teeth are sensitive to hot or cold stimuli. This happens because of the wearing off of the tooth enamel, dentin (a tissue that lies beneath the enamel) and receding gums. Receding gums expose the tooth roots. The exposed roots contain small pores which lead directly to the nerve of the tooth. Pain, pressure, and cold stimuli travel down the pores and trigger the tooth nerves causing pain and discomfort. Healthy gums cover the tooth roots and prevent stimuli to reach the roots.

3. Dry mouth- Saliva has protective effect on the mouth and teeth and it aids chewing too. The salivary glands become somewhat slow with age, producing lesser saliva. This causes dry mouth and difficulty in chewing. Also, there are several medications that we take that reduce the flow of saliva.

4. Root decay- As the tooth roots get exposed due to gum recession, they get exposed to bacteria and hence more susceptible to decay.

5. Darkened teeth- Teeth get stained after years of consuming food and stain inducing liquids like tea, coffee etc. It can also be due to changes to dentin.

6. Tooth and gum decay- Due to less protection of saliva, chances of tooth and gum decay increase.

7. Brittleness of teeth- The root pulp supports the necessary blood vessels and nerves. Root pulp becomes smaller with age and hence unable to provide sufficient support to the nerves and blood vessels, making the teeth fragile. Teeth also become brittle due to insufficient nutrition. Brittle teeth break away easily and the pain experienced during breakage is less due to the lack of the supporting nervous system.

8. Denture fitting- Dentures are supported by ridges in the mouth, which start shrinking once the person loses his original teeth. Thinning of the supportive gum tissue also occurs. Managing dentures therefore becomes a problem and they have to got refitted.

9. Oral cancers- Elders are more susceptible to oral cancers.

10. Gum disease- Gum disease is a major factor in tooth loss. It can occur due to various reasons like ill fitting dentures, tobacco use, unhealthy diet and food left between teeth, all forming plaque. Diabetes and cancer also cause gum disease.

The bacteria in the mouth along with mucus and other particles constantly form a sticky, colorless ‘plaque’ on teeth. The plaque that is not removed by brushing and flossing harden and form ‘tartar’. Tartar is difficult to remove by simple brushing. It has to be cleaned professionally by a dentist. Plaque and tartar if unremoved lead to ‘Gingivitis’ and ‘Periodontitis’.

Gingivitis- The bacteria in the plaque and tartar cause inflammation of the gums that is called ‘Gingivitis’. The gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can be cured by regular brushing, flossing and cleaning by dentist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis- When Gingivitis is not treated it can advance to ‘Periodontitis’ where there is inflammation of the gums around the tooth. The gums pull away from the teeth and form spaces that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. The bacterial toxins and the natural response to infection start to break down the bone and connective tissue that support the teeth are destroyed. The tooth eventually becomes loose and has to be removed.

Symptoms of Gum Disease-
• Red swollen gums
• Bad breath
• Tender and bleeding gums
• Painful chewing
• Loose teeth
• Sensitive teeth
• Receding gums.

Precautions for prevention of geriatric (elderly) dental problems-
1. Brush after every meal.
2. Flossing removes food particles from places where toothbrush cannot reach.
3. Never miss the routine dental check ups.
4. Get well fitting dentures.
5. Use soft brush as the elderly have fragile teeth.
6. Brush gently.
7. Rinse mouth frequently.
8. Increase liquid intake to counter dry mouth.
9. Wipe teeth with gauze if brushing is difficult.
10. Avoid tobacco.
11. Dentures should be cleaned thoroughly.
12. Use specially formulated toothpaste prescribed for sensitive teeth and dry mouth problems.

Sometimes the elders are reluctant or unable to tell there problems. They might even overlook dental problems because of other more demanding health problems. In such cases it is the duty of the family members to watch out for symptoms. Any difficulty in eating may be due to teeth problem which needs to be taken care of immediately.